Insured, but Still Owing $109K for a Heart Attack

Post by citrablue » Tue, Aug 28, 2018, 6:08 PM UTC

lotsofpulp wrote: post #94

treyfitty wrote: post #68

My father had a heart attack 4 months ago, and he’s been in and out of the ICU for 3 of those months. Everyone likes to think “oh, I’m insured. I’ll be fine.” But let me tell you, you won’t be fine. 3 months of ICU at Robert Wood Johnson was billed for $4Mn. BCBS-NJ only paid out $750k. The headache begins there- from a personal financial standpoint, and Tri-party incentive standpoint. Ignoring the difference of $3.2…

Health insurance companies' profit margins are restricted by law, whereas Robert Wood Johnson and its executives and doctors profit margins are not restricted. If anyone is on the patient's side from a cost perspective, it's insurance, and the ones benefiting from higher pricing and unnecessary procedures are the providers.

Post by bobmarley1 » Tue, Aug 28, 2018, 6:09 PM UTC

opencl wrote: post #53

jtokoph wrote: post #7

> UPDATE: Monday, shortly after publication and broadcast of this story by Kaiser Health News and NPR, St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its “financial assistance discount.” Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them.

There is a whole industry of "medical billing advocates" you can pay to find what is likely thousands if not tens of thousands of dollars of completely made up charges on any given US hospital bill and "negotiate" them away. You don't necessarily need press coverage though it obviously helps. Hell one time I got a $15k bill for something insurance should have covered. Called the hospital, turns out insurance had cove…

Post by TomVDB » Tue, Aug 28, 2018, 6:10 PM UTC

cabaalis wrote: post #39

armanini_io wrote: post #24

Only in US.

There are different horror stories from different systems. Bottom line is that access to health care professionals and equipment is a scarce resource, and any resource management process whether through governmental regulation, or individual funding, insurance program, etc will be faced with managing access to that resource one way or another.

Post by bobmarley1 » Tue, Aug 28, 2018, 6:11 PM UTC

jimmydddd wrote: post #93

jhayward wrote: post #11

Earlier quoted context omitted.

> Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them. No, St. David's has already fully recouped their costs and then some. They were simply trying to extract as much money as the stone could bleed.

What's strange is that many hospitals seem to legitimately be in financial trouble. You often hear about smaller hospitals not being able to make it financially, and being gobbled up by larger health networks. How can I be paying them $600 for an asprin, and other fake charges, and they still can't make any money?

Post by nerdponx » Tue, Aug 28, 2018, 6:12 PM UTC

woobar wrote: post #47

cmurf wrote: post #2

FTA St. David’s is out-of-network on his school district health plan So apparently the "max out of pocket" on the cover sheet of your plan is b.s. and only applies in-network. I guess good luck having in-network coverage if you're on a vacation and have an emergency.

Yeah, out-of-network coverage (if provided) is often limited by terms like "the usual, customary, and reasonable amount". When a provider charges unreasonable amount the insurance will not have any contracts that enforce the cost of services. And the patient left holding the bag. ;( My guess is in a situation like this I'd get the reasonable amounts for services provided from my insurer and use them as a basis to ref…